Why I Love and Hate the DSM

As a trauma therapist, I have a complicated relationship with the DSM – the Diagnostic and Statistical Manual of Mental Disorders. The DSM is the book that many therapists, psychiatrists, and mental health professionals use to diagnose mental health conditions. It is one of the most widely used tools in psychology and psychotherapy, and in many ways, it can be incredibly helpful.

But I also believe it deserves to be approached with caution, nuance, and critical thinking.

The DSM continues to evolve and change over time. In fact, many people do not realize that homosexuality was once listed as a mental disorder in earlier versions of the DSM. Today, it is not. That alone tells us something important: diagnoses are not always purely objective truths. They are shaped by culture, politics, social norms, research limitations, and the perspectives of the people creating them.

And historically, many of those perspectives came primarily from white male psychiatrists and research populations that heavily favored white, college-aged men. Because of this, many clinicians and advocates have criticized the DSM for not fully accounting for cultural differences, systemic oppression, trauma, socioeconomic realities, and marginalized experiences. Even today, there are ongoing debates about what should or should not be considered a disorder.

For example, if someone is deeply depressed and anxious because they cannot afford rent, food, or basic survival needs, is that truly a “mental disorder”? Or is it a human response to chronic stress, financial instability, and lack of resources?

This is where my love-and-hate relationship with the DSM begins.

On one hand, diagnoses can be validating. Sometimes clients feel immense relief after finally understanding what they are experiencing. There can be a profound sense of, “Oh… that’s why I feel this way.” A diagnosis can help people feel seen, understood, and less alone.

In trauma therapy, I often see clients who have spent years blaming themselves for symptoms that actually make complete sense in the context of trauma-informed care. Anxiety, hypervigilance, dissociation, panic attacks, emotional dysregulation, and even obsessive thoughts can all develop as survival responses.

For example, one thing I see surprisingly often in trauma therapy is OCD-like symptoms developing after trauma. When the brain, body, and nervous system experience something overwhelming or beyond their control, the mind often tries to regain control by obsessing over details, routines, certainty, or prevention. In many cases, OCD symptoms may not appear “random” at all – they may actually be connected to unresolved trauma.

Similarly, anxiety, depression, PTSD, and OCD can overlap significantly. Sometimes the distinctions between diagnoses become blurry. PTSD and anxiety can look similar. OCD and trauma responses can overlap. Depression can stem from a post-traumatic response due to emotional abuse, narcissistic abuse, sexual abuse, grief, burnout, or chronic invalidation.

And this is one of my biggest frustrations with the DSM: many diagnoses overlap so heavily that people can begin to over-identify with labels rather than understand the deeper root causes underneath them.

I have seen people become so attached to a diagnosis that it starts to define their identity. Instead of viewing the diagnosis as information, they begin to see it as who they are.

And that can become limiting.

Take panic disorder, for example. One of the core components of panic disorder is often the fear of having another panic attack. The more someone identifies with the diagnosis and obsesses over symptoms, the more trapped they may feel within the cycle itself.

This is why I often encourage clients not to over-identify with mental health labels – especially in the era of social media, where mental health content is everywhere. While awareness around mental health is important, self-diagnosing based on TikTok videos or Instagram posts can sometimes create more anxiety than clarity.

Just like people go onto WebMD and convince themselves they have severe medical conditions, the same thing can happen psychologically or in the mental health field.

Having symptoms does not necessarily mean you fully meet criteria for a diagnosis. And even if you do, a diagnosis does not define your worth, identity, or future.

At the same time, I do believe diagnoses can serve an important purpose when used thoughtfully and collaboratively. They can help clients access appropriate care and evidence-based treatment modalities.

For example:

• Someone diagnosed with PTSD may benefit from Eye Movement Desensitization and Reprocessing (EMDR) or somatic trauma therapy.
• Someone struggling with OCD may benefit from Exposure and Response Prevention (ERP).
• Clients diagnosed with Borderline Personality Disorder (BPD) may benefit from Dialectical Behavior Therapy, mindfulness, or trauma-informed care.

In these ways, diagnoses can help guide treatment planning and connect clients to the support they genuinely need.

But I also think clinicians must be mindful and ethical about how diagnoses are used. Mental health labels can carry stigma. In some situations, having certain diagnoses documented in a chart could potentially create unintended consequences if records are requested or viewed by individuals who misunderstand mental health conditions.

Because of this, I often approach diagnosis collaboratively with clients. I like to openly discuss what a diagnosis means to them emotionally and practically. Would receiving a diagnosis feel validating and empowering? Or would it feel overwhelming, stigmatizing, or harmful?

That conversation matters.

As a trauma therapist providing individual therapy, relationship therapy, EMDR therapy, somatic trauma therapy, mindfulness-based approaches, and trauma-informed care in Westlake Village, Thousand Oaks, Agoura Hills, Calabasas, Oak Park, Ventura, Los Angeles, and throughout California, I believe mental health treatment should always remain person-centered first.

Diagnoses can offer language, understanding, and direction. But they should never replace (or outweigh) the complexity of the human experience.

At the end of the day, the DSM is simply a tool – not a definition of who you are.

And like any tool, it can help or harm, depending on how it is used.

— Valeriya Bauer Psychotherapist